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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626215
Report Date: 09/22/2020
Date Signed: 09/22/2020 10:28:34 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JOFEY, SAHRA FAMILY CHILD CAREFACILITY NUMBER:
376626215
ADMINISTRATOR:SAHRA JOFEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 519-4444
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:14CENSUS: 0DATE:
09/22/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sahra JofeyTIME COMPLETED:
10:45 AM
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On 09/22/2020, Licensing Program Analyst (LPA) Elise Read conducted a virtual announced Case Management inspection with the licensee. Due to COVID-19, this inspection took place virtually using Facetime. The purpose of today's inspection is to discuss with the licensee the recent exclusion of Omar Jama, who previously resided at the facility. Present at the time of the inspection were licensee and licensee's minor daughter. Licensee's daughter assisted with translation.

LPA explained the exclusion of Omar Jama to licensee and licensee stated that she understood that Omar Jama is not allowed to be in the home. Licensee stated that she did not have any questions regarding the exclusion. Licensee stated that Omar Jama has moved out of the home.

Licensee was provided the LIC 995B and LIC 995D via email. LPA explained that these forms must be provided to the parents of each child currently enrolled in care. These forms must also be provided to any parent that enrolls their child in the facility in the future. The parents must sign the forms, and licensee must keep the original forms in each child's file. A copy of the forms should be given to the parents. Failure to have these forms in a child's file will result in a $100 civil penalty per file that does not have the forms present. Licensee stated that she understood. Licensee will submit photos of these signed forms to LPA Read for the 8 children enrolled at this time.

No deficiencies cited.

An exit interview was conducted with the licensee. Licensee will be provided a copy of their appeal rights, this report, and a Notice of Site Visit via email. LPA will include the LIC 995B and 995D in this email. Licensee will reply to the email to confirm receipt of these documents. This will act as licensee's signature on today's report.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Elise ReadTELEPHONE: (619) 767-2240
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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